The murmur of ventricular septal defect (VSD) is frequently accompanied by a thrill, and along with the thrill, is best appreciated at the lower left sternal border at the fifth, fourth, and third intercostal spaces.

When the volume of the VSD shunt is large, there will be a consequential S3 and flow rumble at the left ventricular apex. Smaller VSDs and mitral regurgitation of relatively smaller volumes are not accompanied by a third heart sound or flow rumble.

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